‘I’d be happy to tell medical students that saying something is ‘very, very fatal’ isn’t a great comfort to patients.’
Photograph: Sergio Azenha/Alamy

The first time I got cancer, almost everything went wrong. Scans got lost. Letters for appointments arrived after appointments. Mammograms turned out to be X-rays of an ankle. I never found out if the ankle was mine. None of this was quite what I expected when Labour had doubled spending on the NHS. But the real problem, it turned out, was the human beings.

There was, for example, the surgeon who hadn’t bothered to look at my file. “So,” he said, “you’ve had a mastectomy!” I looked at my breasts, which were still there. When I asked him some questions about reconstruction, he said he thought my approach was “rather heavy”. I asked him how light-hearted he would be if someone was about to reconstruct his testicles.

Andrew McDonald, who used to run the parliamentary standards watchdog, Ipsa, spoke about his experience of prostate cancer on the Today programme this week. He mentioned that he’d had a prostatectomy, and that one of the doctors he had seen didn’t realise this since she, too, hadn’t looked at his file. Because she didn’t know this, she told him that a certain test result was “very good news”. When she realised her mistake, she changed her mind. “You’re right,” she said, “this is very bad news. It will be very, very fatal.”

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You can see why McDonald might have thought it was a good idea to take a closer look at communication in the NHS. So, as civil servants like to do, he has written a report. The report, which he has produced for the cancer charity Marie Curie, is called A Long and Winding Road and it argues that bad communication is bad for the taxpayer as well as for the patient. He has even tried to put a cost on it. It costs the NHS about £1bn a year.

The answer, he says, is to give doctors proper training in communication, appoint more clinical nurse specialists to oil the wheels, and make sure that good communication with patients isn’t just seen as a nice-to-have, but not strictly necessary, “soft” skill.

You’d have thought, if you’d managed to spend seven years grappling with medical textbooks, that you might have grasped that being told you’re about to die can make a patient a bit upset, but if we have to teach this – well, fine. For a small charge, I’ll go into medical schools and tell students that saying something is “very, very fatal” isn’t the best way to start.

But it took another doctor to point out this week that the relationship between doctor and patient goes two ways. This doctor is very good at communication. Or perhaps we should just say he’s very clear. This doctor works, or used to work, in A&E. For more than three years, Christian Solomonides made comments on Twitter about his patients that were very clear indeed. He isn’t keen on Muslims and he doesn’t like “feral ignorant council-bred youth”.

He seems, as the associate medical director of his trust told his disciplinary hearing this week, to have a problem with “equality, diversity and discrimination”. He also thinks there are a lot of “ambulatory neurotics” wasting NHS money and time.

On this, at least, he seems to be right. “Ambulance for a broken nail,” he wrote, “an earache, period pain, not being able to sleep are all REAL.” It costs, he added, £1,000 for an ambulance to pick someone up and take them to hospital. “I would say,” he added, “that 90% of call-outs” are “fucking bullshit”.

You might argue with the percentage, and the language, but many doctors in A&E have similar tales. So do many NHS trusts. Broken false nails, chapped lips, lost prescriptions and paper cuts are just some of the “emergencies” doctors in West Yorkshire have had to deal with, and the same is true elsewhere. About a quarter of visits to A&E are related to alcohol. That’s without even thinking about the £300m spent on missed appointments by patients who book them and then can’t be bothered to cancel or turn up.

We are all taxpayers. We are all patients, or will be one day. As taxpayers, we want bang for our buck. As patients, we want the best healthcare we can get. If we want both of these, then patients will have to start behaving like grown-ups and doctors will have to treat us as the polite, but sometimes understandably anxious, adults we are.

When I got cancer the second time, I had to have the mastectomy and reconstruction I had previously managed to avoid. The night before the operation, the plastic surgeon brought me the forms to sign. “It will be fine,” he said, “and if it isn’t, we’ll be with you every step of the way.” That’s communication. That’s class. And I’ll be grateful for his brilliant work until my dying day.